To Evaluate the Performance and Efficiency of Robotic Surgery in Children and Adults

Laparoscopy has been adopted for advantages that include decreased adhesion formation, improved cosmesis, decreased post-operative pain, and shorter recovery times.

The patient benefits of robotic surgery are thought to be essentially the same as conventional laparoscopy: decreased length of stay, decreased blood loss, decreased pain, quicker return to work, and improved cosmetic result through smaller incisions. In pediatric urology, there is evidence that robot-assisted pyeloplasty may be superior to open and laparoscopic approach with decreased length of stay, decreased narcotic use, and decreased operative times.

The overall reported conversion-to-open-procedure rate is low, comparable to the conversion rate in conventional pediatric minimally invasive surgery.

Robotic surgical technology may have a role in pediatric minimal access surgery. Design features of robotic surgical platforms include motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, tremor filtration, instrument indexing, operator controlled camera movement, and elimination of the fulcrum effect. These robotic enhancements offer improvements to conventional minimal access surgery, permitting technical capabilities beyond existing threshold limits of human performance for surgery within the spatially constrained operative workspaces in children. There is evidence that a learning curve is encountered when adopting robotic surgery as demonstrated by decreasing operative times as case volumes increased

At a stand-alone pediatric hospital, a robotic platform is often not available. Only a minority of pediatric hospitals have robotic systems given the limited number of procedures performed nationally. This is probably due to the costs of acquiring and maintaining a surgical robot coupled with the tendency for pediatric hospitals to have less income and fewer eligible patients to defray the fixed costs of the platform. A unique situation exists for pediatric surgeons in hospitals affiliated with adult care as robots may be available that are primarily used for adult subspecialties, most often urology. In this setup, the logistics may be difficult and the pediatric team must be flexible and mobile to accommodate the robot.

Robotic surgery has higher costs than open and laparoscopic procedures. This is due to the high costs of purchasing and maintaining a robot, increased operative time, and costs of disposable surgical supplies.

The specificity of this study is to evaluate the clinical safety and efficiency in a dedicated multidisciplinary pediatric program (gastrointestinal surgery, genitourinary surgery, thoracic surgery, ENT, cardiac surgery and microsurgery) and to evaluate the relative cost of robotic surgery.

• Post-surgery pain with analgesic prescription [Time frame: 6 months]
• Resection quality (R0) of oncologic surgery [Time frame: 6 months]
• Functional results according to the surgery indication [Time frame: 6 months]
• Quality of life (SF-36) [Time frame: 6 months]
• Health survey (EQ-5D-5L) [Time frame: 6 months]
• The Saint-George's hospital Respiratory Questionnaire (SGRQ) [Time frame: 6 months]
• Patient Global Impression of Improvement (PGI-I) [Time frame: 6 months]
• Frequency and percentage of intervention with robot in each speciality [Time frame: 6 months]
• Duration of activity of the operating block [Time frame: 6 months]
• Average duration of anaesthesia [Time frame: 6 months]
• Average duration of robotic surgery and docking [Time frame: 6 months]
• Duration of intervention by speciality (learning curve) [Time frame: 6 months]